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Karaca IR, Ulutürk H, Yilmaz D. Antibiotic usage - Ectopic Impacted Lower Third Molar. J Clin Diagn Res 2016; 10:ZL01-2. [PMID: 27437386 DOI: 10.7860/jcdr/2016/17439.7712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/04/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Inci Rana Karaca
- Professor, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Gazi University , Emek / Ankara, Turkey
| | - Hacer Ulutürk
- Resident, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Gazi University , Emek / Ankara, Turkey
| | - Dervis Yilmaz
- Professor, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Gazi University , Emek / Ankara, Turkey
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102
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Topical Metronidazole in the Management of Rosacea. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2016. [DOI: 10.1097/jdn.0000000000000237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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103
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Nitroimidazole carboxamides as antiparasitic agents targeting Giardia lamblia, Entamoeba histolytica and Trichomonas vaginalis. Eur J Med Chem 2016; 120:353-62. [PMID: 27236016 PMCID: PMC4920673 DOI: 10.1016/j.ejmech.2016.04.064] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/24/2016] [Accepted: 04/25/2016] [Indexed: 11/21/2022]
Abstract
Diarrhoeal diseases caused by the intestinal parasites Giardia lamblia and Entamoeba histolytica constitute a major global health burden. Nitroimidazoles are first-line drugs for the treatment of giardiasis and amebiasis, with metronidazole 1 being the most commonly used drug worldwide. However, treatment failures in giardiasis occur in up to 20% of cases and development of resistance to metronidazole is of concern. We have re-examined 'old' nitroimidazoles as a foundation for the systematic development of next-generation derivatives. Using this approach, derivatisation of the nitroimidazole carboxamide scaffold provided improved antiparasitic agents. Thirty-three novel nitroimidazole carboxamides were synthesised and evaluated for activity against G. lamblia and E. histolytica. Several of the new compounds exhibited potent activity against G. lamblia strains, including metronidazole-resistant strains of G. lamblia (EC50 = 0.1-2.5 μM cf. metronidazole EC50 = 6.1-18 μM). Other compounds showed improved activity against E. histolytica (EC50 = 1.7-5.1 μM cf. metronidazole EC50 = 5.0 μM), potent activity against Trichomonas vaginalis (EC50 = 0.6-1.4 μM cf. metronidazole EC50 = 0.8 μM) and moderate activity against the intestinal bacterial pathogen Clostridium difficile (0.5-2 μg/mL, cf. metronidazole = 0.5 μg/mL). The new compounds had low toxicity against mammalian kidney and liver cells (CC50 > 100 μM), and selected antiparasitic hits were assessed for human plasma protein binding and metabolic stability in liver microsomes to demonstrate their therapeutic potential.
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Hobbs K, Stern-Nezer S, Buckwalter MS, Fischbein N, Finley Caulfield A. Metronidazole-induced encephalopathy: not always a reversible situation. Neurocrit Care 2016; 22:429-36. [PMID: 25561434 DOI: 10.1007/s12028-014-0102-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Metronidazole is a nitroimidazole antimicrobial drug prescribed to treat infections caused by anaerobic bacteria and protozoa. Uncommonly, it causes central nervous system (CNS) toxicity manifesting as metronidazole-induced encephalopathy (MIE). METHODS Case report. RESULTS A 65-year-old woman with hepatitis B cirrhosis (Child-Pugh class C, MELD 21) developed progressive encephalopathy to GCS 4 during a 3-week course of metronidazole for cholecystitis. Initial MRI was consistent with CNS metronidazole toxicity, with symmetrical T2 hyperintensity and generally restricted diffusion in bilateral dentate nuclei, corpus callosum, midbrain, superior cerebellar peduncles, internal capsules, and cerebral white matter. Laboratory values did not demonstrate significant electrolyte shifts, and continuous EEG was without seizure. High-dose thiamine was empirically administered. Lumbar puncture was not performed due to coagulopathy and thrombocytopenia. Despite discontinuation of metronidazole and keeping ammonia levels near normal, the patient did not improve. MRI was repeated 1 week after discontinuation of metronidazole. Although there was decreased DWI hyperintensity in the dentate nuclei, diffuse T2 hyperintensity persisted and even progressed in the brainstem, basal ganglia, and subcortical white matter. Petechial hemorrhages developed in bilateral corticospinal tracts and subcortical white matter. T1 hypointensity appeared in the corpus callosum. She was transitioned to comfort measures only and died 12 days later. CONCLUSION MIE is an uncommon adverse effect of treatment with metronidazole that characteristically affects the dentate nuclei but may also involve the brainstem, corpus callosum, subcortical white matter, and basal ganglia. While the clinical symptoms and neuroimaging changes are usually reversible, persistent encephalopathy with poor outcome may occur.
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Affiliation(s)
- Kyle Hobbs
- Department of Neurology and Neurological Sciences, Stanford University Medical Center, 300 Pasteur Drive, MC 5778, Stanford, CA, 94305, USA
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105
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Świtała M, Poźniak B, Pasławska U, Grabowski T, Motykiewicz-Pers K, Bobrek K. Metronidazole pharmacokinetics during rapid growth in turkeys - relation to changes in haemodynamics and drug metabolism. J Vet Pharmacol Ther 2016; 39:373-80. [PMID: 26813708 DOI: 10.1111/jvp.12283] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 11/10/2015] [Indexed: 12/14/2022]
Abstract
Whereas interspecies variation in pharmacokinetics is a commonly investigated issue, variations in drug kinetics within a species are less documented. The aim of the study was to assess the influence of age-related changes in haemodynamics on the pharmacokinetics of metronidazole (MTZ) and its hydroxy metabolite (MTZ-OH) in turkeys. MTZ was administered intravenously and orally at a dose of 25 mg/kg. Plasma drug and metabolite concentrations were assessed by high-performance liquid chromatography, and pharmacokinetic parameters were calculated by noncompartmental analysis. Haemodynamic parameters (heart rate, stroke volume, cardiac output) were assessed by echocardiography and extraction ratio for MTZ was calculated based on total body clearance (ClB ). Between the 5th and 15th week of age, ClB of MTZ decreased from 3.6 to 1.2 mL/min/kg causing a twofold increase in the mean residence time (MRT) and elimination half-life (T1/2el ). The MTZ-OH production decreased threefold and its MRT and T1/2el increased. Although heart rate significantly decreased with age, cardiac output increased. Extraction ratio was low in all age groups. It is concluded that significant age-dependent decrease in ClB of MTZ in turkeys resulted from decreased perfusion of the clearing organs and their reduced metabolic capacity. This phenomenon is probably species specific and may apply to other therapeutic agents.
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Affiliation(s)
- M Świtała
- Department of Biochemistry, Pharmacology and Toxicology, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - B Poźniak
- Department of Biochemistry, Pharmacology and Toxicology, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - U Pasławska
- Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | | | - K Motykiewicz-Pers
- Department of Biochemistry, Pharmacology and Toxicology, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - K Bobrek
- Department of Epizootiology and Clinic of Birds and Exotic Animals, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
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Safavi M, Sabourian R, Foroumadi A. Treatment of Helicobacter pylori infection: Current and future insights. World J Clin Cases 2016; 4:5-19. [PMID: 26798626 PMCID: PMC4714294 DOI: 10.12998/wjcc.v4.i1.5] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/07/2015] [Accepted: 11/04/2015] [Indexed: 02/05/2023] Open
Abstract
Helicobacter pylori (H. pylori) is an important major cause of peptic ulcer disease and gastric malignancies such as mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma worldwide. H. pylori treatment still remains a challenge, since many determinants for successful therapy are involved such as individual primary or secondary antibiotics resistance, mucosal drug concentration, patient compliance, side-effect profile and cost. While no new drug has been developed, current therapy still relies on different mixture of known antibiotics and anti-secretory agents. A standard triple therapy consisting of two antibiotics and a proton-pump inhibitor proposed as the first-line regimen. Bismuth-containing quadruple treatment, sequential treatment or a non-bismuth quadruple treatment (concomitant) are also an alternative therapy. Levofloxacin containing triple treatment are recommended as rescue treatment for infection of H. pylori after defeat of first-line therapy. The rapid acquisition of antibiotic resistance reduces the effectiveness of any regimens involving these remedies. Therefore, adding probiotic to the medications, developing anti-H. pylori photodynamic or phytomedicine therapy, and achieving a successful H. pylori vaccine may have the promising to present synergistic or additive consequence against H. pylori, because each of them exert different effects.
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107
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Kurt Ö, Doğruman Al F, Tanyüksel M. Eradication of Blastocystis in humans: Really necessary for all? Parasitol Int 2016; 65:797-801. [PMID: 26780545 DOI: 10.1016/j.parint.2016.01.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/30/2015] [Accepted: 01/14/2016] [Indexed: 02/01/2023]
Abstract
Blastocystis (initially named as Blastocystis hominis) has long been known as a protist without any clinical significance. However, there is now a huge pile of case reports where Blastocystis is blamed for the symptoms and the infection described in the patients. Introduction of the presence of as many as 17 Blastocystis subtypes while many infected individuals are non-symptomatic initially brought about the correlation between the subtypes and pathogenicity; however, the outcomes of these trials were not consistent and did not explain its pathogenicity. Today, it is mostly acknowledged that Blastocystis may colonize many individuals but the infection's onset depends on the interaction between the virulence of parasites and host's immune competence. Eradication of Blastocystis is essential in some cases where it is the only infectious agent and patient is suffering from some symptoms. In such cases, metronidazole is the drug of choice but its efficacy is relatively low in some cases. Other agents used include trimethoprim-sulfamethoxazole, paromomycin, and furazolidone. Recent studies on the interactions between human health and the role of gut microbiota introduces new data which may significantly change our point of view against some protists, which we tend to see as "parasites requiring urgent eradication for cure". May the presence or absence of some Blastocystis subtypes necessary for human health, or is the absence or presence of certain Blastocystis subtypes in human gut is associated with certain diseases/infections? The answers of these questions will surely guide us to select patients requiring treatment against Blastocystis infection in future.
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Affiliation(s)
- Özgür Kurt
- Faculty of Medicine, Department of Medical Microbiology, Acibadem University, Istanbul, Turkey.
| | - Funda Doğruman Al
- Faculty of Medicine, Department of Medical Microbiology, Gazi University, Ankara, Turkey.
| | - Mehmet Tanyüksel
- Faculty of Medicine, Department of Medical Microbiology, Gülhane Military Medical Academy, Ankara, Turkey.
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García-Holley P, Ortiz-Pastrana N, Toscano RA, Flores-Álamo M, Barba-Behrens N. Versatile coordination modes of ronidazole towards transition metal ions: five and seven membered chelate rings; supramolecular networks. Polyhedron 2016. [DOI: 10.1016/j.poly.2015.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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109
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Bae EH, Ma SK, Kim SK, Kim SW. Metronidazole-Induced Encephalopathy: A Case Report. J NIPPON MED SCH 2016; 83:44-5. [DOI: 10.1272/jnms.83.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Medical School, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Korea
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Wei TT, Sun JH, Han LW, Chen K, Wang ZQ, Ji H. Effects of the ornidazole enantiomers on the central nervous system: Involvement of the GABAA receptor. Chem Biol Interact 2015; 242:163-9. [PMID: 26415617 DOI: 10.1016/j.cbi.2015.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 09/05/2015] [Accepted: 09/22/2015] [Indexed: 11/28/2022]
Abstract
This is the preliminary study of the sedative and muscle relaxation activity of ornidazole enantiomers, which are widely used in the treatment of susceptible protozoal infections and anaerobic bacterial infections. Adverse effects on the central nervous system (CNS) are the main side effects of ornidazole during its clinical application. The aim of this study was to compare the different central inhibitory effects between S-(-) ornidazole and R-(+) ornidazole in mice and clarify the possible mechanisms. In the present study, central effects of ornidazole were evaluated by open-field test and rota-rod test, and such effects were reversed by pre-treatment with flumazenil (i.p., 10 mg/kg) suggesting that ornidazole exhibits such action by interacting with the GABAergic system. Then, the functional difference between S-(-) ornidazole and R-(+) ornidazole was further explored by evaluating the contents of glutamate (Glu) and γ-aminobutyric acid (GABA) in the brain, and Western blot was used to measure glutamic acid decarboxylase (GAD65/67) expression in the mice cerebral cortex. We found that R-(+) ornidazole mediated an increase in GABA level while decreased the level of glutamate through upregulation of GAD65/67 in the cerebral cortex. Taken together, our study suggests that R-(+) ornidazole mediate stronger central inhibitory effects than S-(-) ornidazole through interaction with the GABAergic system.
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Affiliation(s)
- Ting-Ting Wei
- Department of Pharmacology, China Pharmaceutical University, Nanjing, 210009, China
| | - Ji-Hong Sun
- Department of Pharmacology, China Pharmaceutical University, Nanjing, 210009, China
| | - Lu-Wei Han
- Nanjing Sanhome Pharmaceutical Co., Ltd., Nanjing, 210000, China
| | - Ke Chen
- Department of Pharmacology, China Pharmaceutical University, Nanjing, 210009, China
| | - Zhi-Qiang Wang
- Nanjing Sanhome Pharmaceutical Co., Ltd., Nanjing, 210000, China
| | - Hui Ji
- Department of Pharmacology, China Pharmaceutical University, Nanjing, 210009, China.
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Abstract
Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated and nosocomial infectious diarrhea. Presenting as clostridium difficile colitis, it is a significant cause of morbidity and mortality. Metronidazole is regarded as the agent of choice for CDl therapy and also for the first recurrence in most patients with mild to moderate CDI. Vancomycin is recommended as an initial therapy for patients with severe CDI. With recent Food and Drug Administration-approval fidaxomicin is available for clinical use and is as effective as vancomycin with lower relapse rates. Rifaximin and fecal bacteriotherapy are alternative approaches in patients with severe or refractory CDI, before surgical intervention. Antibiotic research is ongoing to add potential new drugs such as teicoplanin, ramoplanin, fusidic acid, nitazoxanide, rifampin, bacitracin to our armamentarium. Role of toxin-binding agents is still questionable. Monoclonal antibody and intravenous immunoglobulin are still investigational therapies that could be promising options. The ongoing challenges in the treatment of CDI include management of recurrence and presence of resistance strains such as NAP1/BI/027, but early recognition of surgical candidates can potentially decrease mortality in CDI.
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Abstract
In situforming gel with solvent exchange mechanism is one of drug delivery systems for periodontitis treatment. The system is injected into the desired site then transforms into a gel state when the solvent diffuses out and aqueous diffuses in. Thein situforming Eudragit RSgels loading 1, 5 and 10%w/w metronidazole (MT) were developed in this study usingN-methyl pyrrolidone (NMP), 2-pyrrolidone and dimethyl sulfoxide (DMSO) as solvent. The viscosity of the gel systems in all solvents were increased as drug or polymer amount was increased with Newtonian flow behavior. Transformation into gel was evident after initiated the systems in phosphate buffer pH 6.8. NMP systems exhibited the lowest work of syringeability through 18 G syringe. Drug release from dialysis tube of DMSO systems was slower than that of NMP and 2-pyrrolidone systems, respectively. Antimicrobial activity againstStaphylococcus aureusof the systems comprising MT using NMP as solvent was greater than that using 2-pyrrolidone and DMSO, respectively, which the antimicrobial activity was increased as the drug amount was increased. Therefore, the solvent type affected the viscosity, gel formation, syringeability, drug release and antimicrobial activity of Eudragit RS systems. These developed systems sustained the drug release and inhibited the bacterial growth hence they were interesting systems for periodontitis treatment.
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Mode of action and bactericidal properties of surotomycin against growing and nongrowing Clostridium difficile. Antimicrob Agents Chemother 2015; 59:5165-70. [PMID: 26055381 DOI: 10.1128/aac.01087-15] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/05/2015] [Indexed: 01/05/2023] Open
Abstract
Surotomycin (CB-183,315), a cyclic lipopeptide, is in phase 3 clinical development for the treatment of Clostridium difficile infection. We report here the further characterization of the in vitro mode of action of surotomycin, including its activity against growing and nongrowing C. difficile. This was assessed through time-kill kinetics, allowing a determination of the effects on the membrane potential and permeability and macromolecular synthesis in C. difficile. Against representative strains of C. difficile, surotomycin displayed concentration-dependent killing of both logarithmic-phase and stationary-phase cultures at a concentration that was ≤16× the MIC. Exposure resulted in the inhibition of macromolecular synthesis (in DNA, RNA, proteins, and cell wall). At bactericidal concentrations, surotomycin dissipated the membrane potential of C. difficile without changes to the permeability of propidium iodide. These observations are consistent with surotomycin acting as a membrane-active antibiotic, exhibiting rapid bactericidal activities against growing and nongrowing C. difficile.
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Amaya-Guio J, Martinez-Velasquez MY, Viveros-Carreño DA, Sierra-Barrios EM, Grillo-Ardila CF. Antibiotic treatment for the sexual partners of women with bacterial vaginosis. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd011701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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115
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Asín-Prieto E, Soraluce A, Trocóniz IF, Campo Cimarras E, Sáenz de Ugarte Sobrón J, Rodríguez-Gascón A, Isla A. Population pharmacokinetic models for cefuroxime and metronidazole used in combination as prophylactic agents in colorectal surgery: Model-based evaluation of standard dosing regimens. Int J Antimicrob Agents 2015; 45:504-11. [DOI: 10.1016/j.ijantimicag.2015.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 01/08/2015] [Accepted: 01/10/2015] [Indexed: 01/22/2023]
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Tarral A, Blesson S, Mordt OV, Torreele E, Sassella D, Bray MA, Hovsepian L, Evène E, Gualano V, Felices M, Strub-Wourgaft N. Determination of an optimal dosing regimen for fexinidazole, a novel oral drug for the treatment of human African trypanosomiasis: first-in-human studies. Clin Pharmacokinet 2015; 53:565-80. [PMID: 24535888 PMCID: PMC4037587 DOI: 10.1007/s40262-014-0136-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background and Objectives Fexinidazole is a 5-nitroimidazole recently included in a clinical efficacy trial as an oral drug for the treatment of human African trypanosomiasis (HAT). Preclinical studies showed it acts as a pharmacologically active pro-drug with two key active metabolites: sulfoxide and sulfone (the most active metabolite). The present studies aimed to determine the best dose regimen for the treatment of stage 2 sleeping sickness patients, which could eventually also treat stage 1 patients. Methods Fexinidazole was assessed in 154 healthy adult male subjects of sub-Saharan African origin. Three initial first-in-human studies and two additional studies assessed a single ascending dose and multiple ascending doses (both under fasted conditions), tablet versus suspension formulation and food effect (fasted vs. high-fat meal and field-adapted food), and multiple ascending doses with a loading dose regimen under fed conditions. Results Fexinidazole was well-tolerated in a single dose from 100 to 3,600 mg, with quick absorption of the parent drug and rapid metabolism into sulfoxide [time to maximum concentration (tmax) 2–5 h] and sulfone (tmax 18–24 h). The tablet formulation was approximately 25 % less bioavailable than the suspension, and food intake increased drug absorption and plasma concentrations of fexinidazole and its two metabolites by approximately 200 %. Fourteen-day multiple ascending dosing administered up to 3,600 mg/day in fasted conditions showed that fexinidazole was generally well-tolerated (mild to moderate, spontaneously reversible drug-related adverse events). Following the high-fat food effect finding, another study was conducted to evaluate the impact of a low-fat regimen closer to that of the target population, showing that the type of meal does not influence fexinidazole absorption. The last study showed that a loading dose of 1,800 mg/day for 4 days followed by a 1,200 mg/day regimen for 6 days with a normal meal provided the desired exposure of fexinidazole and its metabolites, particularly sulfone, with good tolerability. Based on preclinical evidence from a chronic infection mouse model, systemic drug concentrations obtained are expected to be clinically effective in stage 2 HAT. Conclusions These studies show that fexinidazole can be safely assessed in patients as a potential oral cure for both stages of HAT. Electronic supplementary material The online version of this article (doi:10.1007/s40262-014-0136-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antoine Tarral
- Drugs for Neglected Diseases Initiative (DNDi), 15 Chemin Louis-Dunant, 1202, Geneva, Switzerland,
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Cavera VL, Volski A, Chikindas ML. The Natural Antimicrobial Subtilosin A Synergizes with Lauramide Arginine Ethyl Ester (LAE), ε-Poly-l-lysine (Polylysine), Clindamycin Phosphate and Metronidazole, Against the Vaginal Pathogen Gardnerella vaginalis. Probiotics Antimicrob Proteins 2015; 7:164-71. [DOI: 10.1007/s12602-014-9183-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sequential therapy versus standard triple therapy for Helicobacter pylori eradication in children: any advantage in clarithromycin-resistant strains? Eur J Gastroenterol Hepatol 2014; 26:1202-8. [PMID: 25171023 DOI: 10.1097/meg.0000000000000190] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE There has been a marked decrease in the eradication rates of Helicobacter pylori infection with standard triple therapy worldwide. Hence, sequential therapy has gained attention as a promising treatment during the last few years. This study was carried out to compare the efficacy of sequential versus standard triple therapy in the context of clarithromycin (CLA) resistance. MATERIALS AND METHODS In this study, children between 3 and 18 years of age, who had documented H. pylori infection, were randomized to receive either standard triple or sequential therapy. H. pylori eradication was ascertained using the C-urea breath test 4-6 weeks after the completion of the treatment. Real-time PCR was performed on gastric biopsy samples for assessment of CLA resistance. RESULTS In all, 148 children (median age: 12.18±3.51 years) were recruited randomly into the study. The intention-to-treat eradication rates were 50% (37/74) for the sequential treatment group and 52.7% (39/74) for the standard triple treatment group (P=0.87). A total of 136 children completed the study. The per-protocol eradication rates were 56% (37/66) and 55.7% (39/70) for sequential and standard triple therapy groups, respectively. CLA resistance was assessed and 113 children were included in the final analysis. Of 113 participants, 53 were in the sequential treatment group and 60 were in the standard triple treatment group. The success rates of the respective therapies (29/53=54.7% in sequential, 33/60=55% in standard therapy) were similar (P=0.98). CLA resistance was detected in 29 (25.7%) of the patients. Eradication rates with sequential therapy in CLA susceptible and resistant cases were 60.5% (23/38) and 40% (6/15), respectively (P=0.23). The corresponding figures for the standard triple treatment group were 63% (29/46) and 28.6% (4/14) (P=0.033). Although a higher eradication rate was observed in CLA-resistant cases with sequential therapy, the difference did not reach statistical significance (P=0.69). CONCLUSION In this study, standard triple treatment failed to eradicate H. pylori infection in the majority of the children, and sequential therapy offered only a small advantage over standard triple therapy in the eradication of CLA-resistant strains.
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ter Laak TL, Kooij PJF, Tolkamp H, Hofman J. Different compositions of pharmaceuticals in Dutch and Belgian rivers explained by consumption patterns and treatment efficiency. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2014; 21:12843-55. [PMID: 24972658 DOI: 10.1007/s11356-014-3233-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/18/2014] [Indexed: 05/15/2023]
Abstract
In the current study, 43 pharmaceuticals and 18 transformation products were studied in the river Meuse at the Belgian-Dutch border and four tributaries of the river Meuse in the southern part of the Netherlands. The tributaries originate from Belgian, Dutch and mixed Dutch and Belgian catchments. In total, 23 pharmaceuticals and 13 transformation products were observed in samples of river water collected from these rivers. Observed summed concentrations of pharmaceuticals and transformation products in river water ranged from 3.5 to 37.8 μg/L. Metformin and its transformation product guanylurea contributed with 53 to 80 % to this concentration, illustrating its importance on a mass basis. Data on the flow rate of different rivers and demographics of the catchments enabled us to calculate daily per capita loads of pharmaceuticals and transformation products. These loads were linked to sales data of pharmaceuticals in the catchment. Simple mass balance modelling accounting for human excretion and removal by sewage treatment plants revealed that sales could predict actual loads within a factor of 3 for most pharmaceuticals. Rivers that originated from Belgian and mixed Dutch and Belgian catchments revealed significantly higher per capita loads of pharmaceuticals (16.0 ± 2.3 and 15.7 ± 2.1 mg/inhabitant/day, respectively) than the Dutch catchment (8.7 ± 1.8 mg/inhabitant/day). Furthermore, the guanylurea/metformin ratio was significantly lower in waters originating from Belgium (and France) than in those from the Netherlands, illustrating that sewage treatment in the Belgian catchment is less efficient in transforming metformin into guanylurea. In summary, the current study shows that consumption-based modelling is suitable to predict environmental loads and concentrations. Furthermore, different consumption patterns and wastewater treatment efficiency are clearly reflected in the occurrence and loads of pharmaceuticals in regional rivers.
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Affiliation(s)
- Thomas L ter Laak
- KWR Watercycle Research Institute, P.O. Box 1072, 3430 BB, Nieuwegein, Netherlands,
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Men J, Gao B, Yao L, Zhang Y. Preparation and Characterization of Metronidazole-Surface Imprinted Microspheres MIP-PSSS/CPVA for Colon-Specific Drug Delivery System. JOURNAL OF MACROMOLECULAR SCIENCE PART A-PURE AND APPLIED CHEMISTRY 2014. [DOI: 10.1080/10601325.2014.953376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Affiliation(s)
- Jenana Halilovic
- Infectious Diseases, Department of Pharmaceutical Services, University of California Davis Health System, Sacramento
| | - Brett H. Heintz
- Internal Medicine and Infectious Diseases, Department of Pharmaceutical Services, Iowa City Veterans Affairs Healthcare System
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122
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Lamont HF, Blogg HJ, Lamont RF. Safety of antimicrobial treatment during pregnancy: a current review of resistance, immunomodulation and teratogenicity. Expert Opin Drug Saf 2014; 13:1569-81. [PMID: 25189188 DOI: 10.1517/14740338.2014.939580] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The extent of antibiotic use in pregnancy remains unknown but may occur in > 40% of pregnant women for various indications, at different gestational ages from different sources. AREAS COVERED Antibiotic resistance, alterations to the neonatal immune system causing allergy, asthma and atopic disease in later life and teratogenicity. EXPERT OPINION Although teratogenesis is not a major concern, it is important, and ignorance and complacency cast a long shadow. Robust evidence exists to guide clinicians in their choice of a safe agent with respect to teratogenicity. Antibiotic resistance is a major safety concern, and together with decreased research and development of new antibiotic agents, it has required legal initiatives to encourage Big Pharma to search for safe alternatives. New information from culture-independent, molecular-based techniques has resulted in a greater understanding of the adverse effects of antepartum/intrapartum antibiotics on the maternal vaginal microbiome and the neonatal gut microbiome. As this might adversely affect the development of the immature immune system and lead to asthma, allergy and atopic disease in later life, new research merits support in scrutinizing the safety of antibiotic use in pregnancy.
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Affiliation(s)
- Harriet F Lamont
- University of Southampton, Southampton General Hospital, Faculty of Medicine , Tremona Road, Southampton, SO16 6YD , UK
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Li X, Xu G. Simultaneous determination of ranitidine and metronidazole in pharmaceutical formulations at poly(chromotrope 2B) modified activated glassy carbon electrodes. J Food Drug Anal 2014; 22:345-349. [PMID: 28911424 PMCID: PMC9354867 DOI: 10.1016/j.jfda.2013.09.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/14/2013] [Accepted: 09/23/2013] [Indexed: 11/08/2022] Open
Abstract
A simple and sensitive electrochemical method for the simultaneous and quantitative detection of ranitidine (RT) and metronidazole (MT) was developed, based on a poly (chromotrope 2B) modified activated glassy carbon electrode (PCHAGCE). The PCHAGCE showed excellent electrocatalytic activity toward the reduction of both RT and MT in 0.1 mol/L phosphate buffer solution (pH 6.0). The peak-to-peak separations for the simultaneous detection of RT and MT between the two reduction waves in cyclic voltammetry were increased significantly from ~0.1 V at activated GCE, to ~0.55 V at PCHAGCE. By differential pulse voltammetry techniques, the reduction peak currents of RT and MT were both linear over the range of 1.0 × 10−5–4.0 × 10−4 mol/L. The detection limits (S/N = 3) were 5.4 × 10−7 mol/L and 3.3 × 10−7 mol/L for RT and MT, respectively. The modified electrode was successfully applied to the determination of RT and MT in pharmaceutical preparations and human serum as real samples with stable and reliable recovery data.
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Nagel R, Bielefeldt-Ohmann H, Traub R. Clinical pilot study: efficacy of triple antibiotic therapy in Blastocystis positive irritable bowel syndrome patients. Gut Pathog 2014; 6:34. [PMID: 25349629 PMCID: PMC4209510 DOI: 10.1186/s13099-014-0034-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/07/2014] [Indexed: 02/08/2023] Open
Abstract
Background Blastocystis species are common human enteric parasites. Carriage has been linked to Irritable Bowel Syndrome (IBS). Treatment of Blastocystis spp. with antimicrobials is problematic and insensitive diagnostic methods and re-infection complicate assessment of eradication. We investigated whether triple antibiotic therapy comprising diloxanide furoate, trimethoprim/sulfamethoxazole and secnidazole (TAB) given to diarrhoea-predominant IBS (D-IBS) patients positive for Blastocystis would achieve eradication. Methods In a longitudinal, prospective case study 10 D-IBS Blastocystis-positive patients took 14 days of diloxanide furoate 500 mg thrice daily, trimethoprim/sulfamethoxazole 160/80 mg twice daily and secnidazole 400 mg thrice daily. Faecal specimens were collected at baseline, day 15 and 4 weeks after completion of TAB. Specimens were analysed using faecal smear, culture and polymerase chain reaction (PCR) of the 16 SSU rRNA. Patients kept a concurrent clinical diary. Results Six (60%) patients cleared Blastocystis spp. after TAB, including three who had failed previous therapy. Subtypes detected were ST3 (60%), ST4 (40%), ST1 (20%) and ST7, 8 (10%); four patients had mixed ST infections. Serum immunoglobulin A (IgA) levels were low in 40% of patients. Higher rates of Blastocystis clearance were observed in patients symptomatic for less than a year (Mann–Whitney, p = 0.032, 95% confidence) with no associations found with age, previous antibiotic therapy, faecal parasite load, ST, IgA level or clinical improvement. Conclusions Clearance of Blastocystis spp. was achieved with TAB in 60% of D-IBS patients, an improvement over conventional monotherapy. Higher clearance rates are needed to facilitate investigation of the relevance of this parasite in clinically heterogenous IBS.
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Affiliation(s)
- Robyn Nagel
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia ; Toowoomba Gastroenterology Clinic, Suite 105 Medici Medical Centre, 15 Scott Street, Toowoomba 4350, Queensland, Australia
| | - Helle Bielefeldt-Ohmann
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia ; Australian Infectious Diseases Research Centre, The University of Queensland, St. Lucia, Australia
| | - Rebecca Traub
- Faculty of Veterinary Science, The University of Melbourne, Parkville 3052, Victoria, Australia
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Enantioselective HPLC determination and pharmacokinetic study of secnidazole enantiomers in rats. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 965:224-30. [DOI: 10.1016/j.jchromb.2014.06.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/26/2014] [Accepted: 06/29/2014] [Indexed: 11/19/2022]
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Cao Y, Zhao M, Wu X, Guo B, Chen Y, Yu J, Cao G, Zhang J, Shi Y, Zhang Y. Quantification of levornidazole and its metabolites in human plasma and urine by ultra-performance liquid chromatography-mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 963:119-27. [PMID: 24953495 DOI: 10.1016/j.jchromb.2014.05.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/24/2014] [Accepted: 05/28/2014] [Indexed: 11/16/2022]
Abstract
We developed and validated an ultra-performance liquid chromatographic (UPLC) method coupled with atmospheric pressure chemical ionization (APCI) mass spectrometry for simultaneous determination of levornidazole and its first-pass metabolites, l-chloro-3-(2-hydroxymethyl-5-nitro-l-imidazolyl)-2-propanol (Ml), 2-methyl-5-nitroimidazole (M2) and 3-(2-methyl-5-nitro-1-imidazolyl)-1,2-propanediol (M4), in human plasma and urine. The biological samples were pretreated by protein precipitation and liquid-liquid extraction and analyzed using an ACQUITY UPLC CSH C18 column (2.1×50 mm, 1.7 μm) and a QTRAP mass spectrometer in multiple reaction monitoring mode via APCI. Acetonitrile and 0.1% formic acid in water was used as the mobile phase in gradient elution at a flow rate of 0.6 mL/min. The lower limit of quantification of this method was 0.0100, 0.00500, 0.0200 and 0.00250 μg/mL for levornidazole, M1, M2 and M4, respectively. The linear calibration curves were obtained for levornidazole, M1, M2, and M4 over the range of 0.0100-5.00, 0.00500-2.50, 0.0200-10.0 and 0.00250-1.25 μg/mL, respectively. The intra- and inter-batch precision was less than 12.2% in plasma and less than 10.8% in urine. The intra- and inter-batch accuracy was 87.8-105.7% in plasma and 92.8-109.2% in urine. The mean recovery of levornidazole, M1, M2 and M4 was 91.1-105.1%, 95.8-103.8%, 87.8-96.8%, 96.8-100.6% from plasma and 96.0-100.9%, 96.9-107.9%, 95.1-102.7%, 103.7-105.9% from urine respectively. This method was validated under various conditions, including room temperature, freeze-thaw cycles, long-term storage at -40 ± 5°C, after pretreatment in the autosampler (at 10°C), and 10- and 100-fold dilution. This newly established analytical method was successfully applied in a pharmacokinetic study following single intravenous infusion of levornidazole in 24 healthy Chinese subjects.
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Affiliation(s)
- Yuran Cao
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Miao Zhao
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Xiaojie Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Beining Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Yuancheng Chen
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Jicheng Yu
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Guoying Cao
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, 12 Middle Wulumuqi Road, Shanghai 200040, China.
| | - Yaoguo Shi
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, 12 Middle Wulumuqi Road, Shanghai 200040, China
| | - Yingyuan Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, 12 Middle Wulumuqi Road, Shanghai 200040, China
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Sundara Rajan S, Cavera VL, Zhang X, Singh Y, Chikindas ML, Sinko PJ. Polyethylene glycol-based hydrogels for controlled release of the antimicrobial subtilosin for prophylaxis of bacterial vaginosis. Antimicrob Agents Chemother 2014; 58:2747-53. [PMID: 24566190 PMCID: PMC3993243 DOI: 10.1128/aac.02446-14] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/21/2014] [Indexed: 12/31/2022] Open
Abstract
Current treatment options for bacterial vaginosis (BV) have been shown to be inadequate at preventing recurrence and do not provide protection against associated infections, such as that with HIV. This study examines the feasibility of incorporating the antimicrobial peptide subtilosin within covalently cross-linked polyethylene glycol (PEG)-based hydrogels for vaginal administration. The PEG-based hydrogels (4% and 6% [wt/vol]) provided a two-phase release of subtilosin, with an initial rapid release rate of 4.0 μg/h (0 to 12 h) followed by a slow, sustained release rate of 0.26 μg/h (12 to 120 h). The subtilosin-containing hydrogels inhibited the growth of the major BV-associated pathogen Gardnerella vaginalis with a reduction of 8 log10 CFU/ml with hydrogels containing ≥15 μg entrapped subtilosin. In addition, the growth of four common species of vaginal lactobacilli was not significantly inhibited in the presence of the subtilosin-containing hydrogels. The above findings demonstrate the potential application of vaginal subtilosin-containing hydrogels for prophylaxis of BV.
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Affiliation(s)
- Sujata Sundara Rajan
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Veronica L. Cavera
- Department of Microbial Biology and Biochemistry, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Xiaoping Zhang
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Yashveer Singh
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Michael L. Chikindas
- School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Patrick J. Sinko
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Amdany HK, Mcmillan M. Metronidazole intravenous formulation use in in-patients in Kapkatet District Hospital, Kenya: a best practice implementation project. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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129
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Bhesaniya K, Chavda K, Sadhu C, Baluja S. Thermodynamic characteristics of solutions of ornidazole in different organic solvents at different temperatures. J Mol Liq 2014. [DOI: 10.1016/j.molliq.2013.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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130
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Seña AC, Bachmann LH, Hobbs MM. Persistent and recurrentTrichomonas vaginalisinfections: epidemiology, treatment and management considerations. Expert Rev Anti Infect Ther 2014; 12:673-85. [DOI: 10.1586/14787210.2014.887440] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Tinidazole has been used for bacterial vaginosis (BV) outside the USA for almost four decades. Tinidazole has recently been resurrected and FDA approved for trichomoniasis and BV in the USA and is being restudied as an alternative to metronidazole for BV. In vitro antimicrobial activity and pharmacokinetics studies indicate that when compared directly with metronidazole, tinidazole has minor but possibly relevant antimicrobial as well as pharmacokinetic advantages. Clinical comparisons have been infrequent, although the limited head-to-head studies indicate minimal therapeutic advantage with tinidazole. Perhaps the more relevant differences relate to the enhanced tolerance and reduced toxicity of tinidazole. Currently, studies are still ongoing directly comparing the clinical efficacy of metronidazole and tinidazole. These studies should establish the role of tinidazole in the treatment of BV; however, cure rates are unlikely to be significantly different.
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Affiliation(s)
- Michael D Nailor
- Wayne State University School of Medicine, Detroit Receiving Hospital, Department of Pharmacy, Detroit, MI 48201, USA.
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Metronidazole and hydroxymetronidazole central nervous system distribution: 2. cerebrospinal fluid concentration measurements in patients with external ventricular drain. Antimicrob Agents Chemother 2013; 58:1024-7. [PMID: 24277050 DOI: 10.1128/aac.01762-13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study explored metronidazole and hydroxymetronidazole distribution in the cerebrospinal fluid (CSF) of brain-injured patients. Four brain-injured patients with external ventricular drain received 500 mg of metronidazole over 0.5 h every 8 h. CSF and blood samples were collected at steady state over 8 h, and the metronidazole and hydroxymetronidazole concentrations were assayed by high-pressure liquid chromatograph. A noncompartmental analysis was performed. Metronidazole is distributed extensively within CSF, with a mean CSF to unbound plasma AUC0-τ ratio of 86% ± 16%. However, the concentration profiles in CSF were mostly flat compared to the plasma profiles. Hydroxymetronidazole concentrations were much lower than those of metronidazole both in plasma and in CSF, with a corresponding CSF/unbound plasma AUC0-τ ratio of 79% ± 16%. We describe here for the first time in detail the pharmacokinetics of metronidazole and hydroxymetronidazole in CSF.
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Metronidazole and hydroxymetronidazole central nervous system distribution: 1. microdialysis assessment of brain extracellular fluid concentrations in patients with acute brain injury. Antimicrob Agents Chemother 2013; 58:1019-23. [PMID: 24277041 DOI: 10.1128/aac.01760-13] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The distribution of metronidazole in the central nervous system has only been described based on cerebrospinal fluid data. However, extracellular fluid (ECF) concentrations may better predict its antimicrobial effect and/or side effects. We sought to explore by microdialysis brain ECF metronidazole distribution in patients with acute brain injury. Four brain-injured patients monitored by cerebral microdialysis received 500 mg of metronidazole over 0.5 h every 8 h. Brain dialysates and blood samples were collected at steady state over 8 h. Probe recoveries were evaluated by in vivo retrodialysis in each patient for metronidazole. Metronidazole and OH-metronidazole were assayed by high-pressure liquid chromatography, and a noncompartmental pharmacokinetic analysis was performed. Probe recovery was equal to 78.8% ± 1.3% for metronidazole in patients. Unbound brain metronidazole concentration-time curves were delayed compared to unbound plasma concentration-time curves but with a mean metronidazole unbound brain/plasma AUC0-τ ratio equal to 102% ± 19% (ranging from 87 to 124%). The unbound plasma concentration-time profiles for OH-metronidazole were flat, with mean average steady-state concentrations equal to 4.0 ± 0.7 μg ml(-1). This microdialysis study describes the steady-state brain distribution of metronidazole in patients and confirms its extensive distribution.
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de C Bergamaschi C, Berto LA, Venâncio PC, Cogo K, Franz-Montan M, Motta RHL, Santamaria MP, Groppo FC. Concentrations of metronidazole in human plasma and saliva after tablet or gel administration. ACTA ACUST UNITED AC 2013; 66:40-7. [PMID: 24341948 DOI: 10.1111/jphp.12161] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/16/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to determine the pharmacokinetic profile of metronidazole (Mtz) tablet and to compare Mtz gel and tablet concentrations in both blood plasma and saliva. METHODS In this randomized cross-over study with a 1-week washout period, 13 volunteers randomly received one (a single oral dose of 750 mg Mtz (Flagyl®--tablet) and 2) 3 g of 15% Mtz benzoate gel (applied by using a dental tray). The HPLC with ultraviolet detection was used to quantify plasma and saliva concentrations of Mtz. The pharmacokinetic parameters (PPs) areas under the curves from 0 to 48 h (AUC0-48) and from 0 to infinity (AUC0-∞), the maximum plasma concentration (C(max)), the time to C(max), volume of distribution and renal clearance were determined for Mtz tablet. KEY FINDINGS Considering the Mtz tablet, plasma showed higher Mtz concentration from 6 to 24 h after drug administration and the highest values concerning AUC0-48 h and AUC0-∞ than those obtained in saliva (P < 0.05). No significant differences were observed between plasma and saliva concentrations for Mtz gel. CONCLUSIONS The study showed that some PPs were higher in plasma (P < 0.05) than in saliva concerning Mtz tablet. Gel formulation had similar Mtz bioavailability in plasma and saliva resulting in systemic absorption.
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Coşkun Y, Teber M, Bayrak A, Erarslan E, Yüksel İ. Ornidazole induced acute hepatotoxicity in an elderly patient. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Determining population and developmental pharmacokinetics of metronidazole using plasma and dried blood spot samples from premature infants. Pediatr Infect Dis J 2013; 32:956-61. [PMID: 23587979 PMCID: PMC3769518 DOI: 10.1097/inf.0b013e3182947cf8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Limited pharmacokinetic (PK) data of metronidazole in premature infants have led to various dosing recommendations. Surrogate efficacy targets for metronidazole are ill-defined and therefore aimed to exceed minimum inhibitory concentration of organisms responsible for intra-abdominal infections. METHODS We evaluated the PK of metronidazole using plasma and dried blood spot samples from infants ≤32 weeks gestational age in an open-label, PK, multicenter (N = 3) study using population PK modeling (NONMEM). Monte Carlo simulations (N = 1000 virtual subjects) were used to evaluate the surrogate efficacy target. Metabolic ratios of parent and metabolite were calculated. RESULTS Twenty-four premature infants (111 plasma and 51 dried blood spot samples) were enrolled: median (range) gestational age at birth 25 (23-31) weeks, postnatal age 27 (1-82) days, postmenstrual age 31 (24-39) weeks and weight 740 (431-1466) g. Population clearance (L/h/kg) was 0.038 × (postmenstrual age/30) and volume of distribution (L/kg) of 0.93. PK parameter estimates and precision were similar between plasma and dried blood spot samples. Metabolic ratios correlated with clearance. CONCLUSION Simulations suggested the majority of infants in the neonatal intensive care unit (>80%) would meet the surrogate efficacy target using postmenstrual age-based dosing.
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137
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Carroll MW, Jeon D, Mountz JM, Lee JD, Jeong YJ, Zia N, Lee M, Lee J, Via LE, Lee S, Eum SY, Lee SJ, Goldfeder LC, Cai Y, Jin B, Kim Y, Oh T, Chen RY, Dodd LE, Gu W, Dartois V, Park SK, Kim CT, Barry CE, Cho SN. Efficacy and safety of metronidazole for pulmonary multidrug-resistant tuberculosis. Antimicrob Agents Chemother 2013; 57:3903-9. [PMID: 23733467 PMCID: PMC3719751 DOI: 10.1128/aac.00753-13] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/25/2013] [Indexed: 11/20/2022] Open
Abstract
Pulmonary lesions from active tuberculosis patients are thought to contain persistent, nonreplicating bacilli that arise from hypoxic stress. Metronidazole, approved for anaerobic infections, has antituberculosis activity against anoxic bacilli in vitro and in some animal models and may target persistent, nonreplicating bacilli. In this double-blind, placebo-controlled trial, pulmonary multidrug-resistant tuberculosis subjects were randomly assigned to receive metronidazole (500 mg thrice daily) or placebo for 8 weeks in addition to an individualized background regimen. Outcomes were measured radiologically (change on high-resolution computed tomography [HRCT]), microbiologically (time to sputum smear and culture conversion), and clinically (status 6 months after stopping therapy). Enrollment was stopped early due to excessive peripheral neuropathies in the metronidazole arm. Among 35 randomized subjects, 31 (15 metronidazole, 16 placebo) were included in the modified intent-to-treat analysis. There were no significant differences by arm in improvement of HRCT lesions from baseline to 2 or 6 months. More subjects in the metronidazole arm converted their sputum smear (P = 0.04) and liquid culture (P = 0.04) to negative at 1 month, but these differences were lost by 2 months. Overall, 81% showed clinical success 6 months after stopping therapy, with no differences by arm. However, 8/16 (50%) of subjects in the metronidazole group and 2/17 (12%) of those in the placebo group developed peripheral neuropathy. Subjects who received metronidazole were 4.3-fold (95% confidence interval [CI], 1.1 to 17.1) more likely to develop peripheral neuropathies than subjects who received placebo. Metronidazole may have increased early sputum smear and culture conversion but was too neurotoxic to use over the longer term. Newer nitroimidazoles with both aerobic and anaerobic activity, now in clinical trials, may increase the sterilizing potency of future treatment regimens.
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Affiliation(s)
- Matthew W. Carroll
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Doosoo Jeon
- National Masan Hospital, Changwon, South Korea
| | - James M. Mountz
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jong Doo Lee
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yeon Joo Jeong
- Department of Diagnostic Radiology, Pusan National University School of Medicine, Busan, South Korea
| | - Nadeem Zia
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Myungsun Lee
- International Tuberculosis Research Center, Changwon, South Korea
| | - Jongseok Lee
- International Tuberculosis Research Center, Changwon, South Korea
| | - Laura E. Via
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Soyoung Lee
- International Tuberculosis Research Center, Changwon, South Korea
| | - Seok-Yong Eum
- International Tuberculosis Research Center, Changwon, South Korea
| | - Sung-Joong Lee
- International Tuberculosis Research Center, Changwon, South Korea
| | - Lisa C. Goldfeder
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Ying Cai
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Boyoung Jin
- International Tuberculosis Research Center, Changwon, South Korea
| | - Youngran Kim
- International Tuberculosis Research Center, Changwon, South Korea
| | - Taegwon Oh
- Institute of Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Ray Y. Chen
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Lori E. Dodd
- Biostatistics Research Branch, NIAID, NIH, Bethesda, Maryland, USA
| | - Wenjuan Gu
- Support to Biostatistics Research Branch, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Veronique Dartois
- Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | | | | | - Clifton E. Barry
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Sang-Nae Cho
- International Tuberculosis Research Center, Changwon, South Korea
- Department of Microbiology and Institute of Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, South Korea
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138
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Wang S, Cunha BA, Hamid NS, Amato BM, Feuerman M, Malone B. Metronidazole Single versus Multiple Daily Dosing in Serious Intraabdominal/Pelvic and Diabetic Foot Infections. J Chemother 2013; 19:410-6. [PMID: 17855185 DOI: 10.1179/joc.2007.19.4.410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The purpose of the study was to compare the clinical efficacy of once-daily versus multiple dose regimens of metronidazole in inpatients with serious/systemic Bacteroides fragilis infections, i.e., intraabdominal/pelvic and diabetic foot infections. A retrospective chart review was performed on 145 adult inpatients who received combination therapy with metronidazole for B. fragilis abdominal/pelvic infection or diabetic (deep) foot infections/osteomyelitis. Exclusion criteria included metronidazole given for indications other than those mentioned, patients who received only one dose of metronidazole, and patients who received oral metronidazole only. The 145 patients were in two groups: 66 patients in the metronidazole 1 g (i.v.) q24h (Group A) and 79 patients who received metronidazole 500 mg (i.v./p.o.) q6-8h dosing (Group B). Patient demographics included age, gender, indications of metronidazole, concomitant, antibiotics, and co-morbidities. Data collection also included length of stay (LOS), antibiotic days, and clinical outcomes. The 145 patients in our study had a mean age of 66 years, 61% were female and 39% male. Most patients were being treated for definitive intraabdominal/pelvic infections (82%), or probable intraabdominal/pelvic infections (22%). Only 6% had deep diabetic foot infections of osteomyelitis (percentages exceed 100% since a patient can have more than one indication) and were included since B. fragilis is also and important pathogen in diabetic osteomyelitis. Group A patients had more concomitant antibiotics and co-morbidities (p < 0.0001 and p < 0.05 respectively, chi-square test for trend) than Group B patients. There were no statistically significant differences between groups A and B for LOS and antibiotic days (p = 0.42 and p = 0.92 respectively, by rank-sum test), but after adjusting for concomitant antibiotics and co-morbidities Group A patients had clinically shorter LOS and fewer antibiotic days. Unadjusted mortality and failure rates were non-significantly higher in group A (relative ratios of 12.1%/6.3% = 6.3% = 1.91 and 18.2%/ 10.1% = 1.80 respectively), but after adjusting for concomitant antibiotics and co-morbidities with stratification analysis, groups A and B were virtually the same (risk differences of </= 1%). The authors conclude that for B. fragilis infections, as part of combination therapy, metronidazole 1 g (i.v.) q 24h appears to eb as efficacious and not inferior to multiply-dosed metronidazole regimens. Once daily metronidazole, i.e., 1 g (i.v.) q24h for the treatment of serious systemic infections where B. fragilis is an important co-pathogen (intraabdominal/pelvic and deep diabetic foot infections) has pharmacokinetic and pharmaco-economic advantages.
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Affiliation(s)
- S Wang
- Department of Pharmacy, Winthrop-University Hospital, Mineola, NY 11501, USA.
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139
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Carballo MA, Palermo AM, Mudry MD. Toxicogenetic evaluation of metronidazole in the treatment of women infected withTrichomonas vaginalis. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 98:139-47. [PMID: 15035724 DOI: 10.1179/000349804225003109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Samples of peripheral blood were collected once from non-smoking women who were healthy (controls) and twice (immediately before and immediately after 7 days of treatment with metronidazole at 500 mg/day) from non-smoking women infected with Trichomonas vaginalis. Lymphocyte cultures were prepared and used, in toxicogenetic studies, to determine the frequency of sister-chromatid exchange (SCE), the mitotic index (MI), and the replication index (RI) for each sample. MTZ treatment of the infected women led to an increase in the frequency of SCE (P <0.001), a decrease in the MI (P <0.003), and a modification in the kinetics of cell proliferation, with a decrease in the RI (P <0.0006). The differences seen between the results for the controls and those for the infected women, before and after MTZ treatment, may be attributed to the presence of the parasite, to the treatment itself, and/or to variation in the host's response to infection with T. vaginalis.
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Affiliation(s)
- M A Carballo
- Citogenética y Genética Toxicológica (CIGETOX), Departamento de Bioqúimica Clínica, Facultad de Farmacia y Bioqúimica (FFyB), Universidad de Buenos Aires, Junín 956, (1113), Buenos Aires, Argentina.
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140
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Pearce RE, Cohen-Wolkowiez M, Sampson MR, Kearns GL. The role of human cytochrome P450 enzymes in the formation of 2-hydroxymetronidazole: CYP2A6 is the high affinity (low Km) catalyst. Drug Metab Dispos 2013; 41:1686-94. [PMID: 23813797 DOI: 10.1124/dmd.113.052548] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Despite metronidazole's widespread clinical use since the 1960s, the specific enzymes involved in its biotransformation have not been previously identified. Hence, in vitro studies were conducted to identify and characterize the cytochrome P450 enzymes involved in the formation of the major metabolite, 2-hydroxymetronidazole. Formation of 2-hydroxymetronidazole in human liver microsomes was consistent with biphasic, Michaelis-Menten kinetics. Although several cDNA-expressed P450 enzymes catalyzed 2-hydroxymetronidazole formation at a supratherapeutic concentration of metronidazole (2000 μM), at a "therapeutic concentration" of 100 μM only CYPs 2A6, 3A4, 3A5, and 3A7 catalyzed metronidazole 2-hydroxylation at rates substantially greater than control vector, and CYP2A6 catalyzed 2-hydroxymetronidazole formation at rates 6-fold higher than the next most active enzyme. Kinetic studies with these recombinant enzymes revealed that CYP2A6 has a Km = 289 μM which is comparable to the Km for the high-affinity (low-Km) enzyme in human liver microsomes, whereas the Km values for the CYP3A enzymes corresponded with the low-affinity (high-Km) component. The sample-to-sample variation in 2-hydroxymetronidazole formation correlated significantly with CYP2A6 activity (r ≥ 0.970, P < 0.001) at substrate concentrations of 100 and 300 μM. Selective chemical inhibitors of CYP2A6 inhibited metronidazole 2-hydroxylation in a concentration-dependent manner and inhibitory antibodies against CYP2A6 virtually eliminated metronidazole 2-hydroxylation (>99%). Chemical and antibody inhibitors of other P450 enzymes had little or no effect on metronidazole 2-hydroxylation. These results suggest that CYP2A6 is the primary catalyst responsible for the 2-hydroxylation of metronidazole, a reaction that may function as a marker of CYP2A6 activity both in vitro and in vivo.
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Affiliation(s)
- Robin E Pearce
- Section of Developmental Pharmacology and Experimental Therapeutics, Division of Pediatric Clinical Pharmacology and Therapeutic Innovation, The Children's Mercy Hospitals, Kansas City, MO 64108, USA.
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141
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Sadowska A, Krętowski R, Szynaka B, Cechowska-Pasko M, Car H. Metronidazole decreases viability of DLD-1 colorectal cancer cell line. Cancer Biother Radiopharm 2013; 28:615-22. [PMID: 23777253 DOI: 10.1089/cbr.2013.1485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of our study was to evaluate the impact of metronidazole (MTZ) on DLD-1 colorectal cancer cell (CRC) line. Toxicity of MTZ was determined by MTT test. Cells were incubated with MTZ used in different concentrations for 24, 48, and 72 hours. The effect of MTZ on DNA synthesis was measured as [3H]-thymidine incorporation. The morphological changes in human DLD-1 cell line were defined by transmission electron microscope OPTON 900. The influence of MTZ on the apoptosis of DLD-1 cell lines was detected by flow cytometry and fluorescence microscopy, while cell concentration, volume, and diameter were displayed by Scepter Cell Counter from Millipore. Our results show that cell viability was diminished in all experimental groups in comparison with the control, and the differences were statistically significant. We did not find any significant differences in [3H]-thymidine incorporation in all experimental groups and times of observation. Cytofluorimetric assays demonstrated a statistically significant increase of apoptotic rate in MTZ concentrations 10 and 50 μg/mL after 24 hours; 0.1, 10, 50, and 250 μg/mL after 48 hours; and in all concentrations after 72 hours compared with control groups. In the ultrastructural studies, necrotic or apoptotic cells were occasionally seen. In conclusion, MTZ affects human CRC cell line viability. The reduction of cell viability was consistent with the apoptotic test.
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Affiliation(s)
- Anna Sadowska
- 1 Department of Experimental Pharmacology, Medical University of Bialystok , Bialystok, Poland
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142
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Utility of antimicrobial susceptibility testing in Trichomonas vaginalis-infected women with clinical treatment failure. Sex Transm Dis 2013; 38:983-7. [PMID: 21934577 DOI: 10.1097/olq.0b013e318224db39] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antimicrobial resistance is one of the causes of treatment failure in women after standard nitroimidazole therapy for Trichomonas vaginalis infections. The Centers for Disease Control and Prevention provides drug susceptibility testing and guidance for treatment failures but the efficacy of the alternate recommendations has not been assessed. METHODS T. vaginalis isolates from women who had failed at least 2 courses of standard therapy for trichomoniasis were submitted to the Centers for Disease Control and Prevention for susceptibility testing. Alternative treatment recommendations were provided based on in vitro drug susceptibility results and clinical outcomes were collected. RESULTS Drug susceptibility results were available for 175 women tested between January 2002 and January 2008. In vitro, 115 of the 175 isolates demonstrated metronidazole resistance. For all isolates resistant to metronidazole, in vitro resistance to tinidazole was similar or lower. Clinical treatment outcomes were available for 72 women. Of the women receiving an alternative recommended nitroimidazole regimen, 30 (83%) of 36 were cured compared with 8 (57%) of 14 women who received a lower dose than recommended. Clinical and microbiologic success was attained in 59 (82%) of 72 women whose follow-up information was available, with some women requiring multiple treatment courses. CONCLUSIONS Clinical and microbiologic cure rates were higher for women who were treated in accordance with the recommendation provided after in vitro testing compared with those who received a lower dose or a different drug. Susceptibility testing leading to tailored treatment may have a beneficial role for management of women with persistent trichomoniasis.
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143
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Youssef RM, El-Dlebshany AE, Ragab MAA, El-Kimary EI. MONITORING OF METRONIDAZOLE AND ITS METABOLITE RESIDUES IN EGGS OF TWO STRAINS OF HENS USING HPLC-DAD. J LIQ CHROMATOGR R T 2013. [DOI: 10.1080/10826076.2012.706861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Rasha M. Youssef
- a Faculty of Pharmacy, Department of Pharmaceutical Analytical Chemistry , University of Alexandria , El-Messalah , Alexandria , Egypt
| | - Amira E. El-Dlebshany
- b Faculty of Agriculture, Poultry Production Department , University of Alexandria , El-Shatby , Alexandria , Egypt
| | - Marwa A. A. Ragab
- a Faculty of Pharmacy, Department of Pharmaceutical Analytical Chemistry , University of Alexandria , El-Messalah , Alexandria , Egypt
| | - Eman I. El-Kimary
- a Faculty of Pharmacy, Department of Pharmaceutical Analytical Chemistry , University of Alexandria , El-Messalah , Alexandria , Egypt
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144
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Du J, You T, Chen X, Zhong D. Stereoselective Glucuronidation of Ornidazole in Humans: Predominant Contribution of UDP-Glucuronosyltransferases 1A9 and 2B7. Drug Metab Dispos 2013; 41:1306-18. [DOI: 10.1124/dmd.113.051235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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145
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Simultaneous determination of morinidazole and its carbonylation metabolite in human plasma: Application to a pharmacokinetic study involving renal insufficiency patients and healthy volunteers. J Pharm Biomed Anal 2013; 76:75-80. [DOI: 10.1016/j.jpba.2012.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 11/16/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022]
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146
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Systematic review of randomized trials of treatment of male sexual partners for improved bacteria vaginosis outcomes in women. Sex Transm Dis 2013; 39:822-30. [PMID: 23007709 DOI: 10.1097/olq.0b013e3182631d89] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bacterial vaginosis (BV) affects 10% to 30% of women and recurs in 15% to 30% within 3 months after treatment. BV is not considered an sexually transmitted infection, and treatment of the male sexual partner is not recommended. This recommendation is based on the results of 6 randomized controlled trials (RCTs) of male partner treatment for reducing BV recurrence, which did not find a uniformly beneficial effect. These results are incongruous with epidemiologic and microbiologic data suggesting a sexually transmissible component of BV. In light of this disconnect, the 6 RCTs of male treatment were reviewed to assess validity. METHODS Trials are summarized according to Consolidated Standards of Reporting Trials guidelines. Absolute differences and risk ratios with binomially obtained 95% confidence intervals were estimated. Post hoc power analyses determined the probability of rejecting the null hypothesis for observed relative effect sizes and for the smallest relative effect size detectable with ≥ 80% power. RESULTS Each of the 6 RCTs had significant flaws: randomization methods were either overtly deficient or insufficiently reported; 5 RCTs used suboptimal treatment regimens in women; adherence to treatment in women was not reported in any trial, and adherence in men was reported in only 2 trials; all 6 trials had limited power. None assessed whether antibiotic treatment affected the penile microbiota. CONCLUSIONS Although the RCT is the gold standard for assessing efficacy, biased results can mislead decision making. By current standards, it is unlikely that the results of any of these trials would be considered conclusive. Specific recommendations are made to examine whether BV-associated bacteria may be sexually transferred.
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147
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Jang HJ, Sim SY, Lee JY, Bang JH. Atypical metronidazole-induced encephalopathy in anaerobic brain abscess. J Korean Neurosurg Soc 2012; 52:273-6. [PMID: 23115678 PMCID: PMC3483336 DOI: 10.3340/jkns.2012.52.3.273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 07/09/2012] [Accepted: 08/29/2012] [Indexed: 12/03/2022] Open
Abstract
Metronidazole-induced encephalopathy is a very rare complication of the long standing use of metronidazole. The encephalopathy is bilateral and symmetric in nature. We report on the magnetic resonance imaging (MRI) and clinical course of metronidazole-induced encephalopathy in a 60-year-old female with a persistent anaerobic brain abscess after draining of the abscess. After 3 months of metronidazole administration, the patient complained of dysarthria, tingling sense of all extremities, and left hemiparesis. MRI revealed symmetric hyperintensity lesions in medulla, pons, dentate nuclei of cerebellum, and splenium of corpus callosum, all of which represent typical findings of metronidazole-induced encephalopathy. In addition, asymmetric lesions in midbrain, thalamus, putamen and cerebral subcortical white matter were noted. The patient recovered after discontinuation of metronidazole and the remaining abscess was successfully treated with meropenem and levofloxacine.
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Affiliation(s)
- Han Jin Jang
- Department of Neurosurgery, National Medical Center, Seoul, Korea
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148
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Increased concentration of metronidazole and its hydroxy metabolite in colon cancer in women. Pharmacol Rep 2012; 64:1276-80. [PMID: 23238484 DOI: 10.1016/s1734-1140(12)70924-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 05/10/2012] [Indexed: 11/22/2022]
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149
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Metronidazole prevents reactivation of latent Mycobacterium tuberculosis infection in macaques. Proc Natl Acad Sci U S A 2012; 109:14188-93. [PMID: 22826237 DOI: 10.1073/pnas.1121497109] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Targeting Mycobacterium tuberculosis bacilli in low-oxygen microenvironments, such as caseous granulomas, has been hypothesized to have the potential to shorten therapy for active tuberculosis (TB) and prevent reactivation of latent infection. We previously reported that upon low-dose M. tuberculosis infection, equal proportions of cynomolgus macaques develop active disease or latent infection and that latently infected animals reactivated upon neutralization of TNF. Using this model we now show that chemoprophylaxis of latently infected cynomolgus macaques with 6 mo of isoniazid (INH) effectively prevented anti-TNF antibody-induced reactivation. Similarly, 2-mo treatment of latent animals with a combination of INH and rifampicin (RIF) was highly effective at preventing reactivation disease in this model. Metronidazole (MTZ), which has activity only against anaerobic, nonreplicating bacteria, was as effective as either of these treatments in preventing reactivation of latent infection. Because hypoxic lesions also occur during active TB, we further showed that addition of MTZ to INH/RIF effectively treated animals with active TB within 2 mo. Healing lesions were associated with distinct changes in cellular pathology, with a shift toward increasingly fibrotic and calcified lesions. Our data in the nonhuman primate model of active and latent TB supports targeting bacteria in hypoxic environments for preventing reactivation of latent infection and possibly shortening the duration of therapy in active TB.
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150
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Coskun Y, Erarslan E, Doğan M, Koç H, Yigit SN, Yüksel I. Severe hepatotoxicity as a result of extended use of ornidazole. J Clin Gastroenterol 2012; 46:529-30. [PMID: 22691836 DOI: 10.1097/mcg.0b013e318250056d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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